NR 509 Chamberlain Strategies on How to Approach the Client Next Time Discussion

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 this is a continuity of the previous assignment. discussion to faculty and peer required.

Faculty wants primary care setting.  

From Faculty:

“Thanks for sharing your thoughts on managing violence as a challenging behavior. According to Pitts and Schaller (2022), violence in health care is a critical issue and they cite the Bureau of Labor and Statistics report that health care workers are at a much greater risk for violence from patients than individuals who work in other settings. After the encounter such as yours is over, it is important to reflect and strategize for the next possible encounter. All workplaces, not just psychiatric facilities, should have a plan in place for managing violence”. 

Continue to reflect on this topic. Imagine the scenario when the client returns to your clinical practice for another scheduled encounter. It is understandable to be cautious given your previous experience. Based on what you learned, propose TWO strategies for how you might approach the client differently next time. Be sure to include at least ONE new scholarly source to support your discussion points. Also, can you expand n how previous encounter can be documented using SOAP format?? (Subjective, Objective, Assessment and Plan)

References

Pitts. E., & Schaller. D. J. (2022, March 9). Violent patients. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK537281/ (Links to an external site.)

From Peer:

Talkative Client

Create a sample scenario based on your assigned topic. Describe potential client behaviors consistent with the concern listed.  

    C.L. is a 52-year-old female and is an established patient.  Her concern today when she scheduled her appointment was her blood pressure.  C.L. is very talkative and descriptive in my encounters with her, and at times It is hard to control the conversation.  I have struggled as a new practitioner to be in control of the conversation with her and not let her ramble and go off track with the conversation.  She is very disorganized in her thought process and the visit becomes about multiple other issues other than the reason she is here for a focused visit.  At our visit C.L. describes having headaches, feeling flush, anxious, and a feeling of her heart beating fast.  Upon examination her BP was 172/92 and pulse 92.  During our conversation C.L. also brings up that she could have anxiety, and maybe she is depressed.  The conversation goes all over and its hard to bring it back to the reason she is at the office today.

   Discuss an appropriate and professional approach to address the behavior and communicate with the client

      Active and attentive listening is the heart of patient interviews (Bickley et al, 2021 p. 44).  It is a skill that we will develop over time and helps you structure you interaction with the patient.  It is important to connect with your patient and focus on what they are telling you both verbally and nonverbally (Bickley et al, 2021 p. 61).  A talkative client can pose an issue because as the practitioner we need to learn to control the conversation while allowing the patient to express themselves in a manner that they can find trust in you and feel free to share things that will help you diagnose and treat their clinical situation. Some techniques to incorporate would be to allow the patient to have “free reign of the conversation for about 5-10 minutes.  Try and focus in on what really seems most important to the patient.  Interrupt the patient, when necessary, but be courteous about it.  Summarize in your own words what you thought you heard the patient say, and then ask them to validate that you are focusing on the most important thing they are trying to convey.  Ask questions like “What is your number one concern today that we can take care of”?  Never show impatience with your patient and if time runs out then, ask them to come back in a week and let’s focus on some of the other issues that you brought up today.  Shows concerns for all things mentioned but re-direct to let them know you want to help them solve the problem that is troubling them most (Bickley et al, 2021 pp. 44-49).  Making sure boundaries and expectations are clear with your patients, especially with a patient who is anxious or has verbal outburst.  Work collaboratively with them and use words like “we or us” to help foster mutual respect and responsibility (Breiten et al., 2018).

Provide an example of how you would document the encounter.  

 I would document this encounter using SOAP format:

S= Subjective headaches, feeling flush in her face, anxiousness, feeling of heart beating fast, and feeling lightheaded at times upon standing

O= Objective BP 172/92, pulse 92

A= Assessment  C.L. is a 52-year-old woman with a family history of hypertension.  She comes into the office today complaining of headaches, flush in her face, anxious at times, palpitations and lightheaded.  Upon assessment C. L’s blood pressure was elevated at 172/92 and her pulse was 92. Cindy was very anxious at our visit today and made it difficult to stay on track to discuss what she made her appointment for today as she wanted to discuss multiple other health issues as well.

P= Plan Have C.L. keep a daily blood pressure journal for the next month.  Start her on blood pressure medication such as Lisinopril 5mg, and have her follow up in one month, or call sooner if her blood pressure does not decrease in the next 2 weeks. Have her make another appointment to come in and discuss her anxiety which could be contributing to her elevated BP.

References

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Approach to the clinical encounter. In L. S. Bickley, P. G. Szilagyi, R. M. Hoffman, & R. P. Soriano (Eds.), Bates’ Guide To Physical Examination and History Taking (13th ed, pp. 17-19). Wolters Kluwer.

Breiten, Condie, E., Vaillancourt, S., Walker, J., & Moore, G. (2018). Successfully managing     challenging patient encounters: What role do we play in mitigating or exacerbating difficult situations? American Nurse Today, 13(10), 6–. 

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